摘要
目的 探讨肝硬变门静脉血流动力学的变化及断流术对其影响。方法 应用彩色多普勒流速剖面(CDVP)技术检测 6 9例肝硬变和 46例正常人门静脉主干 (PT)、右前支 (RAB)及脾静脉 (SV)的最大截面平均流速 (CS Vmax)、流量、淤血指数 (CI)。对其中行断流术的 2 8例 ,比较术前、术后各血流动力学指标间的差异。结果 肝硬变组PT、RAB的CS Vmax较正常组显著减慢 ,PT、SV的流量及SV与PT流量比 (SV/PT)较正常组显著增高 ,PT、RAB及SV的CI均比正常组显著增高。断流术后PT流量显著减少 (P <0 0 1) ,减少幅度与术前SV流量显著相关 ( r=0 6 5 ,P <0 0 0 1) ;RAB的CS Vmax和流量均明显下降 ( P <0 0 1) ,流量下降幅度与术前流量呈高度相关 (r =0 74,P <0 0 0 1) ;术后门静脉自由压 (FPP)下降 ( 0 5 9± 0 49)kPa[( 6 0± 5 0 )cmH2 O](P <0 0 0 1)。术前、术后PT、RAB的CI值 ,PT的CS Vmax未发现明显变化。结论 肝硬变时门静脉系处于阻力增高和高动力循环并存状态 ,但不同血管表现侧重不同。SV高动力循环是门静脉血流量增加的主要来源。断流术治疗的主要机制之一是有效地缓解了门静脉系的高动力循环状态。但断流术不能改变高阻力状态 ,高动力循环的缓解使进入肝内的门静脉血流更加减少 。
Objective To investigate portal hemodynamic features and its changes following devascularization in cirrhotics.Methods Hemodynamics of portal trunk(PT),right anterior branch(RAB)and splenic vein(SV),including maximum cross sectional velocity(CS Vmax),flow volume and congestion index(CI),were assessed in 69 cirrhotics and 46 normal volunteers by using a recently developed color Doppler velocity profile(CDVP).Of 28 patients undergone devascularization procedure,portal hemodynamics were studied and compared before and after operation.Results CS Vmax of PT and RAB was significantly lower in cirrhotic group than normal group;PT and SV flow volume and the ratio of SV to PT flow volume(SV/PT)were significantly greater in cirrhotic group compared with those of normal group;CI of PT,RAB and SV was significantly higher in cirrhotic group than normal group.Postoperative PT flow volume was significantly reduced(P<0\^01),and the reduction was closely related to preoperative SV flow volume(r=0\^65,P<0 001).CS Vmax and flow volume in RAB were decreased significantly following operation(P<0\^01),and the reduction of RAB flow volume was highly related to preoperative RAB flow volume(r=0\^74,P<0\^001).After operation,free portal pressure(FPP)was declined by (6±5)cmH\-2O[(0 59±0 49)kPa](P<0\^001).There were no significant changes in CS Vmax,CI in PT and CI in RAB following operation.Conclusion In cirrhotics with portal hypertension,portal venous system coexists the elevated vascular resistance and hyperdynamics,but with different predominance at different portion.SV hyperdynamics is the main source of increased portal blood flow.Devascularization procedure could markedly relieve portal hyperdynamics by elimination of SV inflow,which is one of the main mechanisms in obtaining therapeutic goal.But the operation has no favorable effects on the increased portal resistance,and portal perfusion to the liver would be further declined after relieving portal hyperdynamics,which is unfavorable to maintenance of liver function.
出处
《中国实用外科杂志》
CSCD
北大核心
2001年第3期149-151,共3页
Chinese Journal of Practical Surgery
基金
广东省医学科研基金资助项目 !(B19990 40 )
